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NPI Code Detail

MEDICARE: ANDREA BLASS

MEDICARE: ANDREA BLASS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist22H100629100NJ

General Provider Information

NPI Number : 1639598147
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA BLASS
Provider Business Mailing Address
First Line : 101 SEACREST LN
Second Line :
City : RIO GRANDE
State : NJ
Zip : 08242-2837
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3700 NEW JERSEY AVE
Second Line :
City : WILDWOOD
State : NJ
Zip : 08260-6154
Country : US
Telephone Number : 609-465-0258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2014
Last Update Date : 04/11/2014

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Directions to “ ANDREA BLASS ” Practice Location

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